Improving the quality of care and services
We want to help you live a healthier life — and our National Committee for Quality Assurance (NCQA)-accredited Quality Improvement Program is one of the ways we do it.
NCQA rates health insurance plans based on the results of care that you get and what you say about your care. NCQA also recognizes provider practices that offer high-quality care.
In 2020, BlueCross will maintain NCQA Accreditation for the high quality of care delivered to our members. In addition, we support primary care practices in achieving NCQA Patient Center Medical Home (PCMH) Recognition.
Primary care practices that achieve NCQA PCMH Recognition encourage active collaboration and shared decision-making between patients, families and providers. In addition, PCMH practices deliver more comprehensive care that’s better coordinated and are required to offer appointments in the evenings and/or weekends.
We’ve supported NCQA PCMH Recognition, with NCQA PCMH consultant resources and financially, since 2009. Due to the success of the PCMH program, in 2020 we rebranded it as the Medical Home Partnership (MHP) program, which includes both quality and utilization metrics.
The MHP practices represent 26 primary care practices, 363 locations, 1979 providers and ~387,000 members. The MHP program included a value-based contract in which providers received incentives for high quality (HEDIS measures) and lower utilization.
In 2014, we introduced the Quality Care Partnership Initiative (QCPI), a value-based program, which pays incentives to providers who keep our members healthier by using preventive care and managing chronic conditions (for example, making sure members with diabetes get an annual retinal eye exam and screening for kidney problems). Currently, more than 70 primary care practices are participating in QCPI.
In 2020, we added the Medical Home Partnership (MHP). MHP adds an additional focus on utilization management and coordinating each member’s unique healthcare needs..
How our Quality Care Program works
Our goal is to work with you and your provider to improve your health and to help make sure you get the preventive screenings and tests you need. If our records indicate you may need a particular test, such as a diabetes eye exam, we may send you reminders throughout the year, including:
Health and Wellness
BlueCross provides you with resources to help improve and manage your health. To learn more about these resources, visit bcbst.com/wellnesscenter or call the Member Service number on the back of your Member ID card.
Decision Support Tools
With these resources, you can get help with handling health issues, formulating questions to ask your doctor, understanding symptoms, and exploring health topics and wellness tips that matter to you most. We also offer a shopping and decision support program, and you can obtain information about the average amount paid to network providers and estimates of your out-of-pocket costs for certain items and services by using our healthcare cost estimator.
You can use our Healthcare Cost Estimator by logging in to bcbst.com and clicking Find Care, or by logging into the BCBSTN app and choosing Get Care.
How you can learn more
For more information about quality at BlueCross, please click to view the educational resources below.
Whole-person approach to care
- Mission moment: an outreach call, friendship and a lifesaving test
- The value of a whole-person approach to health care
- From diagnosis to recovery: one member’s cancer and behavioral health journey
- How behavioral and physical health care are closely connected
- A primary care provider: your primary partner in better health
- Improving quality of life while reducing medical costs
- From rock bottom to solid ground – one member’s story
- Why we prioritize senior outreach efforts
- The stars align: how our 4-star rating reinforces our commitment to senior care
If you have questions, please call us at 1-(800) 205-4983.